Purpose: Acute Promyelocytic Leukemia (APL) is a subtype of acute myeloid leukemia with unique cy... more Purpose: Acute Promyelocytic Leukemia (APL) is a subtype of acute myeloid leukemia with unique cytogenetics and clinical presentation. Despite the highest complete remission rates of all the AML subtypes, newly diagnosed APL patients may present with life threatening critical illness. The aim of this study was to describe the characteristics and clinical outcomes of APL patients admitted to an ICU either prior to treatment or during chemotherapy. Methods: We performed a retrospective cohort study including all patients with confirmed APL admitted to the ICU between January 2013 to December 2016. Demographics, comorbidities and diagnoses were collected. Patients were classified into 3 groups based on the timing of diagnosis, administration of treatment and admission to ICU: Group 1 (admitted to ICU prior to induction chemotherapy/ATRA), Group 2 (admitted to ICU during the first month while receiving chemotherapy/ATRA) and Group 3 (admitted to ICU more than one month after post-induction chemotherapy). The primary outcome was ICU mortality. Rates of ICU interventions, disease complications during ICU stay and cause of death were also evaluated. Results: Over a 3-year period, 18 patients with APL were admitted to the ICU. Of these, 44% (n=8) were admitted prior to induction (Group 1), 28% (n=5) peri-induction (Group 2) and 28% (n=5) more than 1 month following induction (Group 3). Median age was 55 (IQR 45-68) and 50% (n=9) were female. Respiratory failure was the most common reason for admission to the ICU (39%, n=7) followed by septic shock (22%, n=4). Overall ICU mortality was 61% (n=11); multi-organ failure the most frequent cause of death (54%, n=6) followed by intracerebral complications (27%, n=3). Mortality was higher in Groups 1 (75%) and 2 (100%) relative to Group 3 (no deaths). Conclusions: Critical illness in patients with APL was associated with high mortality rates if patients were admitted to an ICU early after their initial diagnosis. For patients admitted more than one month after induction chemotherapy, their ICU survival was 100%. Further research is needed to delineate whether conditions associated with earlier deterioration can be predicted and prevented.
Background Structured communication tools for postoperative surgical handover to the intensive ca... more Background Structured communication tools for postoperative surgical handover to the intensive care unit (ICU) have shown promise, yet little work has addressed ongoing daily communication between the surgery and ICU teams thereafter. Objectives Evaluation of a novel, 2‐part communication intervention between surgery and ICU teams focused on postoperative handover and ongoing daily communication. Methods A mixed‐methods, pre‐ and postintervention survey study was conducted in a closed quaternary medical‐surgical ICU. Study participants (N = 112) included ICU physicians, nurses, allied health professionals, and physicians on the surgical team. The intervention consisted of a handover checklist completed postoperatively on arrival in the ICU and a 5‐item communication tool completed daily by the surgical team. Results Satisfaction improved significantly in the following areas: postoperative handover communication (P < .001), daily communication (P = .001), understanding the postoperative plan (P < .001), initiation of deep vein thrombosis prophylaxis (P = .008), initiation of feeding (P = .009), and daily primary resident contact (P = .008). No significant improvement was seen in communication regarding disposition or overall improvement in patient safety risk from communication errors. Conclusions A simple handover checklist improved health care practitioner satisfaction with communication during postoperative handover to the ICU. Concise daily communication tools are an appropriate option for improving ongoing communication between surgeons and the ICU team thereafter.
; for the RECOVER Program Investigators * and the Canadian Critical Care Trials Group BACKGROUND:... more ; for the RECOVER Program Investigators * and the Canadian Critical Care Trials Group BACKGROUND: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. METHODS: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months. RESULTS: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score $ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P ¼ .007), and incomplete secondary education (by 3.8 BDI-II points; P ¼ .009); a curvilinear relation with age (P ¼ .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P ¼ .92), sex (P ¼ .25), ICU LOS (P ¼ .51), or caregiver variables (Caregiver Assistance Scale [P ¼ .28] and Center for Epidemiologic Studies Depression Scale [P ¼ .74]).
Communication skills are important when discussing goals of care and resuscitation. Few studies h... more Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. First-year internal medicine residents. Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop (p = 0.79). The intervention group showed a significant...
Background Few resources are available to support caregivers of patients who have survived critic... more Background Few resources are available to support caregivers of patients who have survived critical illness; consequently, the caregivers' own health may suffer. We studied caregiver and patient characteristics to determine which characteristics were associated with caregivers' health outcomes during the first year after patient discharge from an intensive care unit (ICU). Methods We prospectively enrolled 280 caregivers of patients who had received 7 or more days of mechanical ventilation in an ICU. Using hospital data and self-administered questionnaires, we collected information on caregiver and patient characteristics, including caregiver depressive symptoms, psychological well-being, health-related quality of life, sense of control over life, and effect of providing care on other activities. Assessments occurred 7 days and 3, 6, and 12 months after ICU discharge. Results The…
American journal of respiratory and critical care medicine, Jan 14, 2016
Disability risk groups and one-year outcome after ≥ 7 days of mechanical ventilation in medical /... more Disability risk groups and one-year outcome after ≥ 7 days of mechanical ventilation in medical / surgical ICU patients are unknown and may inform education, prognostication, rehabilitation and study design. To stratify patients for post-ICU disability and recovery to one year after critical illness. We evaluated a multi-center cohort of 391 medical / surgical ICU patients who received ≥ 1 week of MV at 7 days, 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling. The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to one-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay (LOS). By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post ICU healthcare utilization and disposition. Patients < ...
Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continu... more Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continues following discharge from hospital in several patients and becomes a chronic disorder in some. The aim of this study was to describe the etiology of chronic sleep complaints in survivors of ARDS. Methods: Seven ARDS survivors with no previous sleep complaints who reported difficulty sleeping 6 months or more following discharge from hospital were evaluated. Sleep quality was assessed subjectively with a sleep history and the Insomnia Severity Index and objectively with polysomnography. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Results: A chronic sleep disorder was identified in each patient who reported difficulty sleeping. The primary sleep disorder was chronic conditioned insomnia (5 patients), parasomnia (1 patient) and obstructive sleep apnea (1 patient). In addition, 4 patients had periodic leg movements, which was of uncertain clinical significance. Conclusion: Chronic sleep disorders, which originate during the acute illness, are present in some ARDS survivors several months after discharge from hospital. If unrecognized, lack of treatment may contribute to impaired quality of life and incomplete rehabilitation from their critical illness.
Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent ... more Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent complication in survivors of critical illness. The absence of a consistent nomenclature and diagnostic criteria for ICUAW has made research in this area challenging. Although many risk factors have been identified, the data supporting their direct association have been controversial. Presently, there is a growing body of literature supporting the utility and benefit of early mobility in reducing the morbidity from ICUAW, but few centers have adopted this into their ICU procedures. Ultimately, the implementation of such a strategy would require a shift in the knowledge and culture within the ICU, and may be facilitated by novel technology and patient care strategies. The purpose of this article is to briefly review the diagnosis, risk factors, and management of ICUAW, and to discuss some of the barriers and novel treatments to improve outcomes for our ICU survivors.
Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagn... more Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents’ experiences with procedures vary widely, for unclear reasons. Objective: To explore IM residents’ experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience. Methods: Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents’ experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke’s method. Results: We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2020
Purpose Residency programs need to understand the competencies developed by residents during an i... more Purpose Residency programs need to understand the competencies developed by residents during an intensive care unit (ICU) rotation, so that curricula and assessments maximize residents' learning. The primary study objective was to evaluate the feasibility for training programs and acceptability by residents of conducting a multicompetency assessment during a four-week ICU rotation. Methods We conducted a prospective, multicentre observational pilot study in three ICUs. During weeks 1 and 4 of an ICU rotation, we conducted repeated standardized assessments of non-critical care specialty residents' competencies in cognitive reasoning (script concordance test [SCT]), procedural skills (objective structured assessment of technical skills [OSATS]-global rating scale], and communication skills through a written test, two procedural simulations, and a simulated encounter with a ''family member''. The feasibility outcomes included program costs, the proportion of enrolled residents able to complete at least one threestation assessment during their four-week ICU rotation, and acceptability of the assessment for the trainees. Results We enrolled 63 (69%) of 91 eligible residents, with 58 (92%) completing at least one assessment. The total cost to conduct 90 assessments was CAD 33,800. The majority of participants agreed that the assessment was fair and that it measured important clinical abilities. For the 32 residents who completed two assessments, the mean (standard deviation) cognitive reasoning and procedural skill scores increased between weeks 1 and 4 [SCT difference, 3.1 (6.5), P = 0.01; OSATS difference for bag-mask ventilation and central line insertion, 0.4 (0.5) and 0.6 (0.8), respectively; both P B 0.001]. Nevertheless, the communication scores did not change significantly. Conclusions A monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents' cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not.
Context: Research in workplace learning has emphasized trainees' active role in their education. ... more Context: Research in workplace learning has emphasized trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in Intensive Care Units? Methods: In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant Accepted Article This article is protected by copyright. All rights reserved comparative methodology to analyze the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitizing concepts. Results: We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing, and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e., become attuned to task-relevant factors), navigating trajectories (i.e., create and interact with opportunities to perform procedures), and coconstructing trajectories with their peers, supervisors, and interprofessional team members. Conclusions: We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural, and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors, and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritizing certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.
Purpose: Acute Promyelocytic Leukemia (APL) is a subtype of acute myeloid leukemia with unique cy... more Purpose: Acute Promyelocytic Leukemia (APL) is a subtype of acute myeloid leukemia with unique cytogenetics and clinical presentation. Despite the highest complete remission rates of all the AML subtypes, newly diagnosed APL patients may present with life threatening critical illness. The aim of this study was to describe the characteristics and clinical outcomes of APL patients admitted to an ICU either prior to treatment or during chemotherapy. Methods: We performed a retrospective cohort study including all patients with confirmed APL admitted to the ICU between January 2013 to December 2016. Demographics, comorbidities and diagnoses were collected. Patients were classified into 3 groups based on the timing of diagnosis, administration of treatment and admission to ICU: Group 1 (admitted to ICU prior to induction chemotherapy/ATRA), Group 2 (admitted to ICU during the first month while receiving chemotherapy/ATRA) and Group 3 (admitted to ICU more than one month after post-induction chemotherapy). The primary outcome was ICU mortality. Rates of ICU interventions, disease complications during ICU stay and cause of death were also evaluated. Results: Over a 3-year period, 18 patients with APL were admitted to the ICU. Of these, 44% (n=8) were admitted prior to induction (Group 1), 28% (n=5) peri-induction (Group 2) and 28% (n=5) more than 1 month following induction (Group 3). Median age was 55 (IQR 45-68) and 50% (n=9) were female. Respiratory failure was the most common reason for admission to the ICU (39%, n=7) followed by septic shock (22%, n=4). Overall ICU mortality was 61% (n=11); multi-organ failure the most frequent cause of death (54%, n=6) followed by intracerebral complications (27%, n=3). Mortality was higher in Groups 1 (75%) and 2 (100%) relative to Group 3 (no deaths). Conclusions: Critical illness in patients with APL was associated with high mortality rates if patients were admitted to an ICU early after their initial diagnosis. For patients admitted more than one month after induction chemotherapy, their ICU survival was 100%. Further research is needed to delineate whether conditions associated with earlier deterioration can be predicted and prevented.
Background Structured communication tools for postoperative surgical handover to the intensive ca... more Background Structured communication tools for postoperative surgical handover to the intensive care unit (ICU) have shown promise, yet little work has addressed ongoing daily communication between the surgery and ICU teams thereafter. Objectives Evaluation of a novel, 2‐part communication intervention between surgery and ICU teams focused on postoperative handover and ongoing daily communication. Methods A mixed‐methods, pre‐ and postintervention survey study was conducted in a closed quaternary medical‐surgical ICU. Study participants (N = 112) included ICU physicians, nurses, allied health professionals, and physicians on the surgical team. The intervention consisted of a handover checklist completed postoperatively on arrival in the ICU and a 5‐item communication tool completed daily by the surgical team. Results Satisfaction improved significantly in the following areas: postoperative handover communication (P < .001), daily communication (P = .001), understanding the postoperative plan (P < .001), initiation of deep vein thrombosis prophylaxis (P = .008), initiation of feeding (P = .009), and daily primary resident contact (P = .008). No significant improvement was seen in communication regarding disposition or overall improvement in patient safety risk from communication errors. Conclusions A simple handover checklist improved health care practitioner satisfaction with communication during postoperative handover to the ICU. Concise daily communication tools are an appropriate option for improving ongoing communication between surgeons and the ICU team thereafter.
; for the RECOVER Program Investigators * and the Canadian Critical Care Trials Group BACKGROUND:... more ; for the RECOVER Program Investigators * and the Canadian Critical Care Trials Group BACKGROUND: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. METHODS: This study used the Rehabilitation and Recovery in Patients after Critical Illness and Their Family Caregivers (RECOVER) Program (Phase 1) cohort of 391 patients from 10 medical/surgical university-affiliated ICUs across Canada. We determined the association between patient depressive symptoms (captured by using the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson score, and ICU length of stay [LOS]), functional independence measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale and Center for Epidemiologic Studies-Depression Scale) by using linear mixed models at time points 3, 6, and 12 months. RESULTS: BDI-II data were available for 246 patients. Median age at ICU admission was 56 years (interquartile range, 45-65 years), 143 (58%) were male, and median ICU LOS was 19 days (interquartile range, 13-32 days). During the 12-month follow-up, 67 of 246 (27.2%) patients had a BDI-II score $ 20, indicating moderate to severe depressive symptoms. Mixed models showed worse depressive symptoms in patients with lower FIM motor subscale scores (1.1 BDI-II points per 10 FIM points), lower income status (by 3.7 BDI-II points; P ¼ .007), and incomplete secondary education (by 3.8 BDI-II points; P ¼ .009); a curvilinear relation with age (P ¼ .001) was also reported, with highest BDI-II at ages 45 to 50 years. No associations were found between patient BDI-II and comorbidities (P ¼ .92), sex (P ¼ .25), ICU LOS (P ¼ .51), or caregiver variables (Caregiver Assistance Scale [P ¼ .28] and Center for Epidemiologic Studies Depression Scale [P ¼ .74]).
Communication skills are important when discussing goals of care and resuscitation. Few studies h... more Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. First-year internal medicine residents. Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop (p = 0.79). The intervention group showed a significant...
Background Few resources are available to support caregivers of patients who have survived critic... more Background Few resources are available to support caregivers of patients who have survived critical illness; consequently, the caregivers' own health may suffer. We studied caregiver and patient characteristics to determine which characteristics were associated with caregivers' health outcomes during the first year after patient discharge from an intensive care unit (ICU). Methods We prospectively enrolled 280 caregivers of patients who had received 7 or more days of mechanical ventilation in an ICU. Using hospital data and self-administered questionnaires, we collected information on caregiver and patient characteristics, including caregiver depressive symptoms, psychological well-being, health-related quality of life, sense of control over life, and effect of providing care on other activities. Assessments occurred 7 days and 3, 6, and 12 months after ICU discharge. Results The…
American journal of respiratory and critical care medicine, Jan 14, 2016
Disability risk groups and one-year outcome after ≥ 7 days of mechanical ventilation in medical /... more Disability risk groups and one-year outcome after ≥ 7 days of mechanical ventilation in medical / surgical ICU patients are unknown and may inform education, prognostication, rehabilitation and study design. To stratify patients for post-ICU disability and recovery to one year after critical illness. We evaluated a multi-center cohort of 391 medical / surgical ICU patients who received ≥ 1 week of MV at 7 days, 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling. The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to one-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay (LOS). By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post ICU healthcare utilization and disposition. Patients < ...
Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continu... more Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continues following discharge from hospital in several patients and becomes a chronic disorder in some. The aim of this study was to describe the etiology of chronic sleep complaints in survivors of ARDS. Methods: Seven ARDS survivors with no previous sleep complaints who reported difficulty sleeping 6 months or more following discharge from hospital were evaluated. Sleep quality was assessed subjectively with a sleep history and the Insomnia Severity Index and objectively with polysomnography. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. Results: A chronic sleep disorder was identified in each patient who reported difficulty sleeping. The primary sleep disorder was chronic conditioned insomnia (5 patients), parasomnia (1 patient) and obstructive sleep apnea (1 patient). In addition, 4 patients had periodic leg movements, which was of uncertain clinical significance. Conclusion: Chronic sleep disorders, which originate during the acute illness, are present in some ARDS survivors several months after discharge from hospital. If unrecognized, lack of treatment may contribute to impaired quality of life and incomplete rehabilitation from their critical illness.
Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent ... more Intensive care unit-acquired weakness (ICUAW) has been recognized as an important and persistent complication in survivors of critical illness. The absence of a consistent nomenclature and diagnostic criteria for ICUAW has made research in this area challenging. Although many risk factors have been identified, the data supporting their direct association have been controversial. Presently, there is a growing body of literature supporting the utility and benefit of early mobility in reducing the morbidity from ICUAW, but few centers have adopted this into their ICU procedures. Ultimately, the implementation of such a strategy would require a shift in the knowledge and culture within the ICU, and may be facilitated by novel technology and patient care strategies. The purpose of this article is to briefly review the diagnosis, risk factors, and management of ICUAW, and to discuss some of the barriers and novel treatments to improve outcomes for our ICU survivors.
Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagn... more Background: Internal Medicine (IM) residents are required to perform bedside procedures for diagnostic and therapeutic purposes. Residents’ experiences with procedures vary widely, for unclear reasons. Objective: To explore IM residents’ experiences with performing bedside procedures and to identify barriers and facilitators to obtaining sufficient experience. Methods: Using an inductive, thematic approach, we conducted five individual semi-structured interviews and one focus group with seven IM residents (12 residents in total) during the 2017-2018 academic year at a Canadian tertiary care centre. We used iterative, open-ended questions to elicit residents’ experiences, and barriers and facilitators, to performing bedside procedures. Transcripts were analyzed for themes using Braun and Clarke’s method. Results: We identified four themes 1) Patient-specific factors such as body habitus and procedure urgency; 2) Systems factors such as time constraints and accessibility of materials...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2020
Purpose Residency programs need to understand the competencies developed by residents during an i... more Purpose Residency programs need to understand the competencies developed by residents during an intensive care unit (ICU) rotation, so that curricula and assessments maximize residents' learning. The primary study objective was to evaluate the feasibility for training programs and acceptability by residents of conducting a multicompetency assessment during a four-week ICU rotation. Methods We conducted a prospective, multicentre observational pilot study in three ICUs. During weeks 1 and 4 of an ICU rotation, we conducted repeated standardized assessments of non-critical care specialty residents' competencies in cognitive reasoning (script concordance test [SCT]), procedural skills (objective structured assessment of technical skills [OSATS]-global rating scale], and communication skills through a written test, two procedural simulations, and a simulated encounter with a ''family member''. The feasibility outcomes included program costs, the proportion of enrolled residents able to complete at least one threestation assessment during their four-week ICU rotation, and acceptability of the assessment for the trainees. Results We enrolled 63 (69%) of 91 eligible residents, with 58 (92%) completing at least one assessment. The total cost to conduct 90 assessments was CAD 33,800. The majority of participants agreed that the assessment was fair and that it measured important clinical abilities. For the 32 residents who completed two assessments, the mean (standard deviation) cognitive reasoning and procedural skill scores increased between weeks 1 and 4 [SCT difference, 3.1 (6.5), P = 0.01; OSATS difference for bag-mask ventilation and central line insertion, 0.4 (0.5) and 0.6 (0.8), respectively; both P B 0.001]. Nevertheless, the communication scores did not change significantly. Conclusions A monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents' cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not.
Context: Research in workplace learning has emphasized trainees' active role in their education. ... more Context: Research in workplace learning has emphasized trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in Intensive Care Units? Methods: In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant Accepted Article This article is protected by copyright. All rights reserved comparative methodology to analyze the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitizing concepts. Results: We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing, and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e., become attuned to task-relevant factors), navigating trajectories (i.e., create and interact with opportunities to perform procedures), and coconstructing trajectories with their peers, supervisors, and interprofessional team members. Conclusions: We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural, and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors, and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritizing certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.
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Papers by Christie Lee